Objective: to reveal early lung morphological changes after acidin-pepsin aspiration (a combination of hydrochloric acid and proteolytic enzyme). Material and methods. An experiment was made on 30 non-inbred albino male rats whose trachea acidin-pepsin solution (pH 1.2) was administered into. The experiment lasted 1 to 24 hours. Lung histological specimens were stained with hematoxylin and eosin. Results. After an hour of surgery, all the animals developed interstitial edema, had the desquamated bronchial epithelium, segmented leukocytic infiltration of alveolar septa, hemorrhages, and sludges. Conclusion. Acidin-pepsin aspiration leads to the development of acute lung injury verified by morphological studies. Key words: aspiration, acute lung lesion.

Objective: to evaluate the efficiency of methods for diagnosing and treating critically ill patients with acute respiratory failure (ARF) in acute poisoning by neurotropic substances. Subjects and methods. Two hundred and thirty-three patients with acute severe intoxication with neurotropic poisons were examined. All the patients were admitted for toxic-hypoxic coma and ARF; in this connection all the patients underwent artificial ventilation (AV). The patients were divided into 3 groups: 1) those in whom the traditional treatments (AV, detoxifying therapy, and infusional and cardiotropic support) could restore the basic parameters of vital functions, as judged from the recovered oxygenation index; these patients had no metabolic shifts; 2) those who had signs of pulmonary hyperhydration, low cardiac output and moderate metabolic disorders, as suggested by elevated lactate levels; 3) seriously ill patients in whom the interval between the time of poisoning to care delivery was more than 20 hours; the patients of this group had the most significant metabolic disorders. Results. Correction of ARF in critically ill patients with acute poisoning should include, in addition to the rational parameters of AV and detoxifying therapy, agents for targeted therapy for sequels of hypoxia and energy deficiency states. For maximally rapid and effective oxygen transport recovery, the addition of perfluorane to the complex therapy cardinally improves the results of treatment and reduces mortality rates. Conclusion. The complexity of the pathogenesis of ARF and its sequels is a ground for diagnosing and correcting not only ventilation disturbances, but also pulmonary microcirculatory disorders and metabolic disturbances. Key words: acute intoxication with neu-rotropic poisons, acute respiratory failure, pulmonary hyperhydration, hypoxia, metabolic disturbances.

Objective: to determine the causes of preterm labor and the factors contributing to the development of acute respiratory distress syndrome (ARDS) in the newborn. Subjects and methods. The paper presents the results of analyzing case histories and autopsy protocols of preterm neonates who died from ARDS. The study group comprised 20 (36.6%) very low-weight neonatal infants. Twelve (21.8%) neonates out of all the infants received the exogenous surfactants Curosurf and Surfactant BL. Lungs and placentas were histologically studied. Results. The study has demonstrated that various placen-tal abnormalities are one of the risk factors of preterm labor and ARDS. Intranatal amniotic fluid aspiration is a poor predictor. Conclusion. The efficiency of therapy with the exogenous surfactants depends on the quality of care delivered to a baby at birth, the time of switching the patient to artificial ventilation and the time of administration of a surfactant. Exogenous surfactants should be administered only in obstetric facilities that have all conveniences at their disposal to render a specialized aid to preterm infants. Key words: preterm neonate infants, acute respiratory distress syndrome, exogenous surfactants, primary atelectases, hyaline membranes.

Objective: to reveal the clinical and morphological features of nosocomial pneumonia (NP) in patients with generalized peritonitis and to define its role in tanatogenesis. Subjects and methods. The study was based on an analysis of 94 patients with generalized peritonitis and 11 autopsy protocols. Results. The postoperative period was complicated by the development of NP in 46 (48.9%) patients with generalized peritonitis, including ventilator-associated pneumonia (VAP) in 28 (60.9%) cases. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) were diagnosed in 11 and 2 patients, respectively. ALI was followed by NP in 3 patients and revealed in the presence of the latter in 8. VAP antedated ARDS in both cases. In the group of patients with generalized peritonitis, overall and attributive mortality rates were 12.8 and 3.2%, respectively. Conclusion. The present study and the analysis of the results of autopsy protocols have revealed that NP in generalized peritonitis may be both a cause and an effect of ALI, thus playing a significant role in tanatogenesis. Key words: nosocomial pneumonia, acute lung injury, pulmonary edema, peritonitis.

Objective: to compare the efficiency of continuous positive airway pressure (CPAP) and high-frequency jet ventilation by means of a mask (HFJV-M) in the treatment of cardiogenic edema of the lung. Design: a retrospective study. Setting: Department of Anesthesiology and Intensive Medicine, Hospital NsP, Vranov, Slovakia. Subjects and methods. A hundred and ninety-six patients with varying cardiogenic edema of the lung were divided into 3 groups according to the severity of pulmonary edema (PE). By taking into account comparable pharmacotherapy, mean airway pressure, and FiO2, the authors compared the efficiency of CPAP (n=64) and HFJV-M (n=101) from the rate of changes in respiration rate, blood oxygenation, acid-base balance, and the duration of ventilation support and the length of stay in the intensive care unit (ICU). The results were assessed by the unpaired Student’s test. The procedure of artificial ventilation via HFJV-M was approved by the Professional and Ethics Committee, Ministry of Health in the Republic of Slovakia, in 1989 for clinical application. Results. Comparison of CPAP or HFJV-M used in mild PE that was called Phase 1 of PE revealed no statistically significant differences in the parameters being assessed. In severer forms of PE characterized as Phases 2 and 3, the use of HFJV-M in the first 3 hours of ventilation maintenance caused a rapider reduction in spontaneous respiration rate from 25—33 per min to 18—22 per min (p>0.01). The application of HFJV-M also showed a statistically significant difference in the correction rate of PaO2, pH, and oxygenation index (PaO2/FIO2) (p>0.01) predominantly within the first 2 hours of therapy. Comparison of the mean duration of necessary ventilation maintenance (CPAP versus HFJV-M: 10.9 versus 6.8 hours) and the mean length of stay in the ICU (CPAP versus HFJV-N: 2.7 versus 2 days) revealed a statistically significant difference (p>0.01 and p>0.05, respectively). Only 6.6% of the HFJV-M group patients needed intubation and routine ventilation modes. Conclusion. The statistical analysis of controlled parameters (oxygenation, acid-base balance, duration of ventilation maintenance, length of hospital stay, and intubation needs) established that ventilation maintenance by HFJV-M versus CPAP was more effective just in the first 2—5 hours of therapy. When HFJV-M was used, the duration of required ventilation maintenance and the length of stay in the ICU were less since the need for intubation decreased to 6.6%.

Objective: to estimate the implication of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in the pathogenesis of hemostatic disorders, by studying the arteriovenous difference between hemostatic parameters. Subjects and methods. Venous and arterial hemostases were studied in 95 patients treated in an intensive care unit. Three groups were identified, which included: 1) 50 patients with an uncomplicated postoperative period and without any organ incompetence; 2) 21 patients with primary lung injury; and 3) 24 patients with secondary lung injury. Groups 2 and 3 patients were divided according to the degree of acute lung injury. Results. The arterial blood of patients with the uncomplicated postoperative period shows a lower coagulability than venous blood; there is no arteriovenous difference between fibrinolytic activity and platelet levels. The coagulation activity of arterial blood increases in primary lung injury; the higher fibrinolytic activity of arterial blood is a compensatory mechanism in moderate lung injury. Later on, in evolving ARDS, the hemostasiological balance between the pulmonary and systemic circulations impairs; disseminated intravascular coagulation (DIC) develops in both arterial and venous beds. Venous blood coagulability increases in secondary lung injury. By regulating the hemostatic system, the lungs produce a lower coagulation activity of and a higher fibrinolytic activity of arterial blood in ALI. With the development of ARDS, this function triples and DIC spreads to the arterial bed. Conclusion. The lung maintains the hemostasiological balance between the pulmonary and systemic circulations, by holding activated platelets and by enhancing the fibrinolytic activity of the blood flowing from it. The inducer of DIC is the suppressed fibrinolysis of the lesser circulation in patients with primary lung injury and hyperco-agulation in the greater circulation in patients with secondary lung injury. Key words: acute lung injury, arteriovenous hemostasis difference, disseminated intravascular coagulation.

Objective: to evaluate changes in the laboratory markers of endogenous intoxication in acute severe brain injury (SBI) and to define their prognostic significance in the development of pneumonias. Subjects and methods. Sixty-six patients with isolated severe brain injury in the acute phase of the disease were examined and divided into two groups: 1) 35 (53%) patients who were not observed to have pneumonias in the acute period; 2) 31 (47%) who had developed pneumonia on an average of 7.7±2.8 days after injury. Endogenous intoxication was evaluated from the erythrocytic sedimentation rate (ESR), leukocytic indoxication index (LII), the spectrum of serum medium molecular-weight peptides and red blood cells, complements C3, C4, C-reactive protein, soluble fibrin monomer complexes, dienic conjugates, lactic acid, urea, and creatinine. Immunological parameters, such as the total count of lymphocytes and the level of CD3+ lymphocytes (a marker of mature lymphocytes), were studied by indirect monoclonal antibody immunofluorescence. A control group comprised 24 healthy individuals. The data were statistically processed by the Statistica-6 program, by applying Student’s test, and Pearson’s correlation coefficient. Results. Endogenous intoxication was found to be attended by immunodeficiency and to show two waves; just after injury it was caused by diseased and ischemic brain tissue destruction products and its second wave was associated with the development of pneumonias by the end of the first week after injury when an increase in proteolysis products along bacterial toxemia proved to be of significance. The markers, the predictors of pneumonia development in SBI, are increases in ESR up to more than 40 mm/hour on day 3, ESR up to more than 50 mm/hour, and in complement C3 levels up to more than 1.5 g/l on day 5. The early markers of pulmonary complications are increases in serum medium molecular-weight peptide levels up to over 0.3 optical density units at 262 nm, in C-reactive protein up to more than 100 mg/l, and in dienic conjugates up to above 1.2 mmol/l on day 7. The good predictor of the course of pneumonia is an increase in complement C4 levels up to over 0.4 g/l after day 7 and a reduction in LII to less than 3 relative units. Conclusion. The findings show it necessary to include the diagnostic markers: medium molecular-weight peptides, C-reactive protein, and dienic conjugates into the comprehensive examination of patients with severe brain injury. Key words: severe brain injury, endogenous intoxication, C-reactive protein, dienic conjugates, medium molecular-weight peptides, pneumonias.

Increased pulmonary vascular resistance in preterm infants is associated with acute respiratory failure (ARF) and at the same time endothelin-1 (E-1) plays an important role in neonatal pulmonary vascular responsiveness. Methods. Endothelin-1 levels were measured in two blood samples in 12 preterm infants with ARF and in 12 controls (at 32.2±1.3 and 29.8±1.2 weeks of gestation, respectively) by enzyme immunoassay. For this, the first and second blood samples were taken at 18 to 40 hours after birth. Results. The plasma level of E-1 in the first sample did not differ between the neonates of both groups. In the second sample, significantly higher E-1 concentrations were observed in the newborns with ARF than in the controls. In the first sample, E-1 concentration were higher than in the second one in both groups (p<0.001). There was a significant positive correlation between the second E-1 sample and the SNAPPE 2 scale rating (r=0.38; p=0.02). The plasma level of E-1 in the first sample did not differ in both groups (11.9 and 12.2 pg/ml, respectively). Conclusion. Neonates with and without ARF had the similar plasma E-1 levels in the first sample, by taking into account the fact that the E-1 levels were higher in ARF than in the controls at 18 to 40 hour after birth. Increased vascular resistance in ARF may be associated with the high level of E-1. Key words: endothe-lin-1, acute respiratory failure.

Background. Postextubation pulmonary gas exchange dysfunctions are a potential complication in the activation of cardio-surgical patients in the early periods after surgical intervention. Objective: to evaluate the efficiency of noninvasive assisted ventilation (NIAV) as a method for correcting the pulmonary gas exchange disturbances developing after early activation of cardiosurgical patients. Subjects and methods. The study included 64 patients (36 males and 28 females) aged 21 to 72 (54±2) years who had been operated on under extracorporeal circulation (EC). The duration of EC and myocardial ischemia was 104±6 and 73±4 min, respectively. The indications for NIAV were the clinical manifestations of acute respiratory failure (ARF) and/or PaCO2>50 mm Hg and/or PaO2/FiO2Results. During NIAV, there was improvement (p<0.05) of lung oxygenizing function (the increase in PaO2/FiO2 was 23%), a reduction in Qs/Qt from 21.1±1.9 to 13.9±1.0% (p<0.05). NIAV was accompanied by a decrease in PaCO2 (p<0.05). Hypercapnia regressed in 7 patients with isolated lung ventilatory dysfunction (PaCO2>50 mm Hg) an hour after initiation of NIAV. During and after NIAV, there were reductions in right atrial pressure, mean pulmonary pressure, indexed total pulmonary vascular resistance (ITPVR) (p<0.05). Prior to, during, and following NIAV, mean blood pressure, cardiac index, and indexed total pulmonary vascular resstance did not change greatly. In hypercapnia, the duration of NIAV was significantly less than that in lung oxygenizing function (2.8±0.2 hours versus 4.7±0.5 hours). That of ICU treatment was 23±4 hours. Fifty-two (81%) patients were transferred from ICUs to cardiosurgical units on the following day after surgery. Conclusion. In most cases, NIAV promotes a rapid and effective correction of postextubation lung ventilatory and oxygenizing dysfunctions occurring after early activation of cardiosurgical patients. Key words: non-invasive assisted ventilation, early activation of cardiosurgical patients.

Objective: to evaluate the clinical significance of risk factors of acute lung injury (ALI) in cancer patients who have experienced acute excessive intraoperative blood loss (AEIBL), hemorrhagic shock (HS), and acute disseminated intravascular coagulation (DIC), and massive infusion-transfusion therapy. Subjects and methods. Operative days were analyzed in patients from three groups who had sustained AEIBL of 100 to 550% of the circulating blood volume. Group 1 consisted of 14 patients who had experienced HS or HS + acute DIC after extensive intraperitoneal surgical interventions. Group 2 comprised 16 patients who had undergone extensive surgical interventions involving extended thoracic lymph dissection. Group 3 included 15 patients after extensive intraperitoneal surgical interventions. Patients with evolved ALI were identified in each group. In all the patients, an excess (balance) of fluid and oncotic pressure were detected at the end of operative days. Results. There were 4 patients (2 with ALI and 2 with acute respiratory distress syndrome (ARDS)) in Group 1 and 11 patients (2 with ALI and 9 with ARDS) in Group 2. Patients with ALI were not identified in Group 3. At the end of operative days, the excess of fluid turned out to double in patients with evolved ALI/ARDS than in those without signs of respiratory failure. Conclusion. Of the greatest significance in the natural history of ALI in this cohort of patients are the following risk factors: surgical injury and extended thoracic lymph dissection; HS, with cardiovasotonics being used for more than 8 hours; excess fluid accumulation by the end of operative days. The safe excess fluid volume was determined, which was not greater than 50 ml/kg in the patients who had undergone peritoneal surgery and even experienced HS, but with cardiovasotonics being administered for not more than 4 hours. That was 20 ml/kg in those who had sustained excessive surgical injury + thoracic lymph dissection. Key words: acute lung injury, risk factors, infusion therapy, plasma oncotic pressure, fluid balance.

Objective: to enhance the efficiency of intensive therapy and prevention of pyoseptic complications (PSC) of severe concomitant injury. Subjects and methods: A hundred patients who were divided into three groups were examined. A control group consisted of 30 apparently healthy individuals (donors). A study group comprised 38 patients to whom the standard of intensive care and prevention of PSC of severe concomitant injury was applied. A comparison group included 32 patients who received specific preventive therapy for pulmonary PSC, by incubating the cell mass with recombinant interleukin-2. Hemostatic parameters were followed up by biochemical tests and hemoviscosimetry. Immunological parameters, the data of semiquantitative procalcitonin test, and the clinical laboratory parameters of a systemic inflammatory response, as well as complications were analyzed. Results. In the intervention group, the signs of a systemic inflammatory response regressed beginning on day 2 of therapy, the results of the procalcitonin test and vascular thrombocytic hemostasis became normal and the time of respiratory support and the length of intensive care unit stay reduced. Conclusion. The early combination of cell mass with recombinant interleukin-2, beginning on day 2 of therapy for severe concomitant injury, enhances the efficiency of intensive therapy and prevention of pulmonary PSC. Key words: severe concomitant injury, infectious complications, diagnosis, recombinant interleukin-2.

Objective: to evaluate the efficiency of noninvasive supporting ventilation in patients with acute cardiorespiratory failure in the early postoperative period after cardiac surgery under extracorporeal circulation. Methods. Case histories of patients operated on the heart under extracorporeal circulation, who postoperatively developed acute car-diorespiratory failure requiring repeated artificial ventilation (AV), were retrospectively studied. According to the AV mode, the patients were divided into 2 groups. Non-invasive AV was carried out in Group 1 (a study group). In Group 2 (a control group), tracheal intubation and mechanical ventilation were performed when respiratory indices deteriorated. In both groups, anesthesia was maintained without deviating from the clinically accepted protocol. The indications for extubation were routine. Following 24—72 hours after extubation, the health status of patients became worse, as manifested in decreased circulatory performance, requiring that they be switched to AV. Clinical and laboratory findings were used to define indications for AV switching. The conditions for noninvasive ventilation were the close cooperation of a patient with medical personnel, the absence of significant hyperthermia, injury, operation or facial abnormally, which excluded intimate mating. Results. Analysis of gas exchange changes suggests that there are no differences between the groups both just after surgery and within 24 postperfusion hours after extubation. When the condition deteriorated, no differences in oxygen exchange and delivery were observed in the study and control groups. In the control group, PaO2, oxygenation index, and oxygen delivery index were significantly less than those in the study group. Analysis of the duration of assisted ventilation revealed that the study group patients were on a respirator significantly less than the controls. The length of intensive care unit stay also increased greatly in Group 2. All patients with normal gas exchange parameters were transferred to a specialized unit. Complications, such as insignificant skin damages at the site of intimate mask mating, were observed in the study group, while in the control group, ventilator-associated pneumonia was seen in 3 cases. Conclusion. The present study has provided evidence that noninvasive AV may be effective in the occurrence of acute cardiorespiratory failure requiring the correction of gas exchange parameters after surgery under extracorporeal circulation. Key words: noninvasive supporting ventilation, cardiosurgery, extracorporeal circulation.

Objective: to enhance the efficiency of diagnosing acute lung injury (ALI) and fat embolism (FE). Subjects and methods: Forty-seven patients with severe concomitant trauma (SCT), divided into three groups by the severity of shock and injury, were examined. The parameters of the scales rating ALI severity, lipid metabolism, hemostatic system, and hemodynamic monitoring were analyzed. Results. Three types of acute lung injury were identified in FE depending on clinical laboratory parameters: the patients having a shockogenicity index of less than 14 scores had significantly activated coagulation hemostasis and suppressed fibrinolytic system. Those with a shockogenicity index of 15 to 22 scores developed hemostatic disorders as activated coagulation hemostasis throughout the study and considerably activated fibrinolytic system, the levels of atherogenic very low density lipoproteins (LVDL) and triglycerides increased. The patients with a shockogenicity index of more than 23 scores developed hemostatic disorders, such as pronounced activation of the blood coagulation system and suppression of the fibrinolytic system. The manifestation of ALI increased with the elevated concentrations of LVDL and triglycerides, hypercoagulation by hemo-viscosimetric parameters and reduced platelets, lower oxygenation index, and decreased oxygen consumption. Conclusion. A scheme of development of the types of ALI and FE has been proposed. Key words: severe injury, acute lung injury, fat embolism, types of diagnosis.

Objective: to study the impact of administration of surfactant-BL, followed by alveolar mobilization on the parameters of pulmonary oxygenizing function and biomechanics in patients with impaired lung oxygenizing function (ILOF) in the early postoperative period. Subjects and methods. Eight patients aged 48—73 years (mean 59.1±3.0 years) were examined. The indication for alveolar mobilization was an oxygenation index (PaO2/FiO2) of less than 300 mm Hg during artificial ventilation (AV). Alveolar mobilization was carried out under AV, by regulating from the pressure to achieve its airways maximum of 31.6± 1.2 cm H2O and a PEEP of 16.4±0.4 cm H2O. The indication for the use of surfactant-BL (Biosurf, Saint Petersburg) was a reduction of PaO2/FiO2 below 300 mm Hg while attempting to activate the patients. The dose of the agent was 300—450 mg (3.5±0.3 mg/kg) when endobronchially injected. Results. The average increase of PaO2/FiO2 after the first maneuver was 152 mm Hg (p<0.05), that of static thoracopulmonary compliance (Cst) was 12.2 ml/cm H2O (p<0.05); intrapulmonary blood shunting (Qs/Qt) reduced by 5% (p<0.05). On trying to activate the patients, PaO2/FiO2, Cst and Qs/Qt stopped differing from the values recorded before the maneuver. After administering surfactant-BL, followed by alveolar mobilization, there were increases in PaO2/FiO2 (by 177 mm Hg), Cst, and Cdyn (by 15.7 and 14 ml/cm H2O, respectively) (p<0.05). In 7 (87.5%) cases, the trachea was extubated within 6 hours after transferring from the operating suite at a PaO2/FiO2 of 350.9±21.4 mm Hg. Acute respiratory distress syndrome was diagnosed in 1 (12.5%) case. Conclusion. Surfactant-BL substantially enhances the efficiency of the alveolar mobilization maneuver in ILOF early after surgery under extracorporeal circulation. The combined use of the surfactant and the maneuver ensures a stable normalization of the biomechanical properties and oxygenizing function of the lung. There are good grounds to believe that the tested tactics plays a therapeutic and prophylactic role in the early signs of acute lung injury. Key words: impaired lung oxygenizing function, acute lung injury, extracorporeal circulation, pulmonary surfactant system, surfactant-BL, alveolar mobilization, artificial ventilation.

Objective: to study the prevalence of acute transfusion-associated lung injury (TRALI) amongst cardiosurgical intensive care unit (ICU) patients and to assess the contribution of this pathology to the total number of postoperative pulmonary complications and its influence on the course and outcome of the underlying disease. Subjects and methods. 515 patients who had been operated on for cardiovascular diseases at the N. N. Burdenko Main Military Hospital in 2005—2007 were retrospectively examined. A control group included 127 patients operated on without using donor blood preparations in the perioperative period. Results. Ten cases of evolving acute lung injury (ALI) etiologically associated with transfusion therapy were revealed. One case of TRALI was fatal, other cases required prolonged artificial ventilation (mean 36±2.5 hours), the length of their ICU stay increased by an average of 3.2±0.2 days as compared with that in the similar patients receiving no transfusion therapy. Conclusion. In 23% of cases, the development of ALI was etiologically associated with transfusion therapy. The incidence of TRALI was 2.3%; mortality was 10%. At the same time, the majority of the detected cases were not timely recognized as TRALI. The latter required assisted/artificial ventilation and increased length of ICU stay. Key words: acute transfusion-associated lung injury.

Objective: The safety of an alveolar mobilization technique was morphologically evaluated. Materials and methods. Experiments were made on 46 non-inbred albino male rats weighing 280—320 g. Thiopental sodium (15—20 mg/kg animal weight) was intraperitoneally injected for anesthesia. A TSE Animal Respirator was employed for 30—180 minutes. In the first experimental animal group, the ventilation parameters were as follows: air flow 0.4—0.5 l/min; respiration rate 60 per min; tidal volume 1—5 ml; PEEP (during alveolar opening) 40 cm H2O (40 seconds); PEEP (after recruitment) 10 cm H2O (20 minutes). Recruitment was carried out at 20-minute intervals for 1—3 hours. Experimental Group 2 animals underwent artificial ventilation (AV) with the following ventilation parameters: air flow 0.4—0.5 l/min; respiration rate 60 per min; tidal volume 1—5 ml; PEEP (during alveolar opening) 20 cm H2O (20 seconds); PEEP (after recruitment) 10 cm H2O (20 minutes). The control animals had AV with the ventilation parameters: air flow 0.4—0.5 l/min; respiration rate 60 per min; tidal volume 1—5 ml; PEEP 0 cm H2O. Lung pieces were fixed in 10% neutral formalin solution and embedded in paraffin. The histological specimens were stained with hematoxylin and eosin; the Schick test was carried out. Results. Histological study of the lung from the experimental group animals has shown dilated alveoli and bronchioli. The increased alveolar volume at a high air flow and PEEP leads to air-blood barrier damage, alveolar septal infiltration with leukocytes, neutrophils, and macrophages, and to the development of interstitial and alveolar edema. Lung morphological changes were less pronounced in the animals from the second experimental group. Conclusion. The alveolar opening technique improves gas exchange parameters, as evidenced by oxygen utilization. The high PEEP values are attended by more significant lung morphological changes. Key words: alveolar recruitment, open lungs, PEEP.

The review of the literature considers the etiology and pathogenesis of acute lung injury (ALI) in pneumonias. The development of ALI in pneumonias is largely determined by the properties of microorganisms and by the features of the macroor-ganism. The pathogenic properties of microorganisms lead to a damage to the air-blood barrier and to an impairment of the local protective mechanism in the lung. Alveolar damage, a systemic inflammatory reaction, and extracardiac pulmonary edema provoke ALI in pneumonias. The authors show it difficult to make a differential diagnosis and important to detect the early signs of ALI in pneumonias of various genesis. Transpulmonary thermodilution and identification of the markers of alveolar epithelial damage are promising methods. Key words: acute lung injury, pneumonia, sepsis, cytokines, transpul-monary thermodilution.

Based on the analysis of the references given in the Russian and foreign periodicals, the present paper states the current notions of the etiology, epidemiology, and pathogenesis of and the methods for the diagnosis, prevention, and treatment of acute lung injury developing with the use of blood preparations. It shows the difficulties arising in the diagnosis of this complication and presents the algorithms of differential diagnosis and treatment of acute posttransfusion lung injury. The authors describe their own observation of a case of evolving acute posttransfusion lung injury, the used methods of diagnosis, and the results of treatment in detail.

Considering the issues of artificial ventilation (AV) in non-homogenous pathological lung processes (acute lung injury, acute respiratory distress syndrome, pneumonia, etc.), the authors created a mathematical model of multicompartment non-homogenous injured lungs that were ventilated by a new mode of AV, the so-called three-level ventilation. Multilevel ventilation was defined a type (modification) of ALV whose basic ventilation level was produced by the modes CMV, PCV or PS (ASB) and add-on level, and the so-called background ventilation was generated by the levels of PEEP and high PEEP (PEEPh) with varying frequency and duration. Multi-level ventilation on 3 pressure levels was realized by the mathematical model as a combination of pressure-controlled ventilation (PCV) and two levels of PEEP and PEEPh. The objective was to prove that in cases of considerably non-homogenous gas distribution in acute pathological disorders of lungs, gas entry into the so-called slow bronchoalveolar compartments could be improved by multilevel AV, without substabtially changing the volume of so-called fast compartments. Material and Method. Multi-level ventilation at 3 pressure levels was realized by the mathematical model as a combination of PCV and two levels of PEEP and PEEPh. Results. By comparing the single-level AV in the PCV mode with the so-called three-level ventilation defined as a combination of PCV+PEEPh/PEEP, the authors have discovered that the loading of slow compartments in the model was considerably improved by 50—60% as compared with the baseline values. In absolute terms, this difference was as many as 2—10 times of the volume. Conclusion. The mathematical model may demonstrate that the application of the so-called three-level AV causes considerable changes in gas distribution in the lung parenchyma disordered by a non-homogenous pathological process. The authors state that the proposed mathematical model requires clinical verification in order to evaluate the efficiency of this modification of AV. Key words: artificial ventilation, multilevel artificial ventilation, acute lung injury, acute respiratory distress syndrome.

Considering the issues of artificial ventilation (AV) in non-homogenous pathological lung processes (acute lung injury (ALI), acute respiratory distress syndrome (ARDS), pneumonia, etc.), the authors applied the three-level lung ventilation to a group of 12 patients with non-homogenous lung injury. Three-level ventilation was defined as a type (modification) of AV whose basic ventilation level was produced by the modes CMV, PCV or PS (ASB) and add-on level, the so-called background ventilation was generated by two levels of PEEP. PEEP (constant) and PEEPh (PEEP high) with varying frequency and duration of transition between the individual levels of PEEP. Objective: to elucidate whether in cases of considerably non-homogenous gas distribution in acute pathological disorders, three-level ventilation (3LV) can correct gas distribution into the so-called slow bronchoalveolar compartments, by decreasing the volume load of the so-called fast compartments and to improve lung gas exchange, by following the principles of safe ventilation. Results. 3LV was applied to 12 patients with severe non-homogenous lung injury/disorder (atypic pneumonia and ARDS/ALI) and low-success PCV ventilation after recruitment manoeuvre (PaO2 (kPA) /FiO2 = 5—6). There were pronounced positive changes in pulmonary gas exchange within 1—4 hours after initiation of 3LV at a fPCV of 26±4 breaths/min-1 and PEEPh at a fPEEPH of 7±2 breaths/min-1 with a minute ventilation of 12±4 l/min. 3LV reduced a intrapulmonary shunt fraction 50±5 to 30±5%, increased CO2 elimination, with PaCO2 falling to the values below 6±0.3 kPa, and PaO2 to 7.5±1.2 kPa, with FiO2 being decreased to 0.8—0.4. Lung recruitment also improved gas exchange: with PEEP=1.2±0.4 kPa, static tho-racopulmonary compliance (Cst) elevated from 0.18±0.02 l/kPa to 0.3±0.02 l/kPa and then to 0.38±0.05 l/kPa. Airways resistance (Raw) decreased by more than 30%. Improved lung aeration was also estimated as a manifestation of gas distribution with a long time constant. After 5±1-day 3LV, the patients were switched to PS ventilation; after gradually reduction of ventilation maintenance, they were disconnected from a ventilator and transferred to a specialized unit. Conclusion. The small study group made it impossible to statistically assess outcomes; the clinical results are not at least contrary to the results of theoretical mathematic simulation of 3LV in mathematical and physical models. 3LV as compared with PCV applied within the first 2—4 hours of AV improved lung gas exchange. It can be a promising mode of ventilation for the lungs afflicted by a diffusive non-homogenous pathological process. Key words: artificial ventilation, three-level ventilation, acute lung injury, acute respiratory distress syndrome.